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AIDS Research and Treatment
Volume 2017, Article ID 7356362, 11 pages
Research Article

Conceptualising the Factors Affecting Retention in Care of Patients on Antiretroviral Treatment in Kabwe District, Zambia, Using the Ecological Framework

School of Public Health, University of the Western Cape, Cape Town, South Africa

Correspondence should be addressed to Ferdinand C. Mukumbang; moc.liamg@gnabmukum

Received 25 August 2017; Accepted 19 October 2017; Published 9 November 2017

Academic Editor: Robert R. Redfield

Copyright © 2017 Ferdinand C. Mukumbang et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.


Background. HIV remains a major public health challenge in Zambia. The roll-out of antiretroviral treatment (ART) has engendered new challenges in retention in care. Objective. To conceptualise the factors affecting retention in care of ART patients at three primary healthcare facilities using the ecological framework. Method. Qualitative data were collected through in-depth interviews with 45 ART patients and three focus group discussions with 20 healthcare providers from three primary healthcare facilities in Kabwe district, Zambia, and subjected to thematic content analysis. Results. Individual level barriers to retention in care included side effects, gaining weight, belief in faith healing, and use of herbal remedies and alcohol. Interpersonal barriers such as stigma and nondisclosure of HIV status were reported. At the institutional level, inadequate space in the clinic, long waiting times, long travel distances, and shortage of third-line drugs presented barriers to retention in care. Food shortages and patient mobility were reported as community barriers to retention in care. Conclusion. The ecological framework conceptualises the complex and dynamic factors affecting retention in ART care and highlights the need for multifaceted interventions that combine health education, disease management, and opportunities for income generation in a socially responsive and accountable environment.